Among those whose job is emergency management and disaster planning, the question "Where were you on 9/11" has a significantly different meaning than for the man on the street. For planners, it is not where you were physically, but where your facility was in its pursuit of truly being prepared for any biological, natural or man-made disaster?

Ten years and several hurricanes, tornadoes and tsunamis later, hospitals say they are definitely more prepared. But the recession has slowed some of that progress.

"We have tools now we didn't have 10 years ago," said Scott Bitting, MPA, CHPA, at Geisinger Health System, Danville, PA, of the many resources provided and/or paid for by federal and state grants. "But the robust funding we saw initially is diminishing year by year."

Keeping Up to Speed

As federal and state funding -- mainly through the Hospital Preparedness Program administered by the U.S. Department of Health and Human Services -- for planning and durable equipment shrinks, disasters occur that spur preparedness managers to further planning. Hurricane Katrina and the recent deadly tornadoes in Joplin, MO, caused facilities to review their procedures, disaster planners told ADVANCE. The tsunami and nuclear disaster in Japan moved the spotlight to radiation accidents.

"The Joplin tornadoes served as a catalyst to get people talking and reenergize the conversation on preparation," said Christina Hughes, MS, BSN, RN, NREMT-P, director Healthcare System Preparedness for MedStar Health's ER One Institute and emergency preparedness coordinator at Franklin Square Hospital Center, Baltimore. "In the emergency prep world these terrible events can bring about positive change. For example, in Joplin, the hospital phone lines were down so they lost the means to communicate. That was an important lesson about building redundancy."

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"Hospitals are coming together with fire, health department, EMS agencies and policy makers in their communities to ensure we are prepared," Hughes said. (Parenthetically, Hughes pointed out, regional disaster prep collaborations could be "quite useful in the future in that we could share resources and avoid being redundant in purchases should funding be more significantly decreased.")

"In Pennsylvania, there are a couple of new tools we didn't have 10 years ago," said Bitting, director of security and emergency management services and chairman of the Emergency Management Committee at Geisinger. "We're part of the Facility Resource Emergency Database (FRED) system. Through this 800-megahertz statewide hospital radio system all hospitals are linked to speak to each other. We learn about events going on, can inquire about bed capability, etc."

Additionally, Geisinger is part of an interdisciplinary state taskforce where all types of community services meet quarterly to educate and train together for a mass casualty event. This has really boosted communication, said Bitting. "We have trained together so we're more than just a voice on the phone."

When it comes to picking up the phone, Hughes, who chairs two community prep groups in Maryland, says her health system is as ready as can be.

"In Katrina, the only reliable communication was ham radio and runners. So we have built in absolute redundancy with phone, internet and radio," she said. "We purchased satellite phones and have a base station here to communicate across the state. We have VOIP [voice-over internet protocol] lines and we can call upon licensed ham radio operators through the Baltimore County Auxiliary Communications Service."

Chris Hiles, MS, BSN, RN, emergency manager at IEM, an emergency management contracting firm in Research Triangle Park, NC, travels across the country helping facilities develop emergency plans or leading training sessions. "Good communication is key," Hiles said. "If an ambulance company is contracted to your facility, it may work for other hospitals as well. So they're on your books as a resource but they're not really there. That lack of available resources ultimately caused a lot of deaths in Katrina."

Mass Casualty Drilling

Drawing further on communication and collaboration, facilities are getting creative in how they conduct drills. For example, a group of physician instructors at Northwestern University used the Chicago Marathon as a drill site. Sanjeev Malik, MD, assistant medical director, and assistant professor in the Department of Emergency Medicine at Northwestern University Feinberg School of Medicine, and an ED and sports medicine doc at Northwestern Memorial Hospital, co-authored an article in the July issue of Disaster Medicine and Public Health Preparedness on the drill.

"In most cases entities aren't used to working together until an emergency occurs," Malik said. "Part of what we liked about this concept of drilling at the marathon was we need to do a lot of these things anyway and it's a great platform for practicing principles, including improving communication."

In 2007, the October marathon was suspended due to extreme weather conditions ¾ temperatures were 88 degrees with "a high wet bulb temperature," Malik explained. "In communicating that the race was over, officers on the street didn't know if they should close the street, let people walk, or what. The finer details of communication needed to be unified."'

In a similar vein, Franklin Square Hospital Center looks for "interesting ways to practice for emergencies," Hughes pointed out. "An exercise we do annually is a drive-thru flu clinic which tests our emergency preparedness with multiple agencies."

Post-Sept. 11 & Recession

All these drills take planning, money and equipment.

"While we saw robust funding post 9/11 and while it is diminishing year by year, we still do have flexibility in what we're buying," said Bitting. Because of this assistance Geisinger was able to replace makeshift decontamination equipment with a permanent room in their emergency department. "We also have a decon trailer we can roll out, and people are trained to work with the tools. They know how to use chemical monitoring equipment, appropriate respirators and PPE," Bitting said.

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There is a catch however because although these purchases are one-time only they can have components that will expire, Hughes points out. "A lot of our equipment becomes dated, such as some PPE. For example, PAPRs [powered air-purifying respirators] have cartridges that expire. Other equipment has batteries that run out. We have medication caches, such as prophylactic antibiotics for things like anthrax, that have expiration dates."

Helpful Resources

Despite shrinking federal disaster planning grants, there are still resources out there, Hiles said. "The federal government offers technical assistance programs free," Hiles told ADVANCE. "If a class you want to request from FEMA isn't offered, it can be created. If you have problems writing a disaster plan, programs are available through the Federal Emergency Management Agency's Technical Assistance Program just by filling out a one-page request form. And www.ready.gov has a lot of information as well."

Even if you have a plan, these resources might be helpful to keep you current, because as Bitting said: "It's not a good attitude to feel you're 100 percent prepared."

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